Analysis on relationship between the accident and injury occurrence and the absence appearance of adults in South Korea

The purpose of this study is to examine relationship between the accident and injury occurrence and the absence appearance in adults. Materials of this study were based on the raw data of "Korea National Health and Nutrition Examination Survey 2011", which was conducted by the Ministry of Health and Welfare (MW) and Korea Centers for Disease Control and Prevention (CDC) in 2011. Totally 5904 people were targeted by selecting data without missing value in addition to age in more than 20 years old. And the appearance of absence through the occurrence of injury had the final subjects of absence targeting 379 people among 5904 people. An analytical method was made by using SPSS WIN program (Version 12.0). As a result of research, the occurrence of injury was higher (p< 0.01) in men than women. The age group was high in the 30s (about 1.5 times, p< 0.05) and the 40 s (about 1.9 times, p< 0.01). The higher in household income (about 1.5 times, p< 0.05) and educational level (about 1.6 times, p< 0.001) led to the higher occurrence of injury. As for the occurrence of absence, fall and slip (abut 1.8 times, p< 0.05) had higher absence than other accidents. As for a place of cure, the absence were higher (p< 0.001) in users of emergency room than entering hospital/clinic. Finally, the more bed-ridden led to the higher absence (p< 0.001).

Foam formation and acute air emboli with the maquet paediatric Quadrox I: a word of caution

We report 3 cases of significant foam formation in the venous reservoir with the Maquet Quadrox-I oxygenator and VHK 31 000 reservoir system. All the 3 patients required maximal suction return during procedures, causing pressurization of reservoir and foam formation. Two patients experienced systemic air emboli, which were dealt with by means of retrograde cerebral perfusion and hypothermia with no neurological sequela. These events emphasize the importance of device selection in high-risk patients as well as crisis management.

Comparative study of European tunnel emergency-stop-area-wall protection measures

Due to the increasing number of traffic accidents involving the collisions of vehicles with the emergency-stop-area head walls in tunnels, a comparative numerical analysis in accordance with the EN 1317 standard has been performed in order to assess the quality of the available protective safety barriers. Based on the simulation results, the values of the relevant injury criteria - the acceleration severity index (ASI), the theoretical head impact velocity (THIV) and the post-impact head deceleration (PHD) - were computed for several collision scenarios involving two different passenger vehicles colliding with two different safety barriers in various ways. The results show that due to the geometrical restrictions in the tunnel's emergency stop area none of the barriers can provide total protection for the occupants of the vehicle in the event of a collision. The installation of a steel-sheet-tube crash cushion was, however, found to provide the best possible protection within the given limitations. The results of the analysis were the basis for selecting a safety-barrier design for existing tunnel installations and for the proposed changes in regulations governing the geometry of the tunnel's emergency stop area.

An early intervention programme had no detectable influence on the health status of people with musculoskeletal injuries following road traffic crashes: comparative study

OBJECTIVE

To compare the health status of people with minor injuries from road traffic crashes that are exposed to an early, active intervention programme (intervention group) with those receiving usual care (control group) over a 12 month period.

DESIGN

Prospective comparative study using sequential cohorts.

SUBJECTS

People presenting to hospital emergency departments with mild to moderate musculoskeletal injuries following road traffic crashes.

MAIN OUTCOME MEASURES

Physical Component Score (PCS) and Mental Component Score (MCS) of the Short Form 36 (SF-36) health status measure; Hospital Anxiety and Depression Scale (HADS) and the Functional Rating Index (FRI) recorded immediately post-crash, at 6 months and at 12 months after injury.

RESULTS

There were 95 participants allocated to the control group and 98 allocated to the intervention group. Participants were enrolled at a mean of 9.3 days following the crash. There were no significant differences in baseline health measures between the groups. Apart from a small improvement in anxiety for the intervention group, there were no significant differences in health status between the groups. Twenty percent of participants in the intervention group received treatment from external healthcare providers that was inconsistent with the recommendations of the intervention programme.

CONCLUSIONS

The intervention programme failed to result in a clinically significant improvement in health outcomes compared with usual care. There is some evidence to suggest that the intervention had some psychological benefits, as evidenced by the small improvement in anxiety levels. Limited adherence, frequent use of co-interventions, or other factors (such as intervention content or intensity) may have reduced its effect.

Reliability and validity of a safety climate questionnaire

BACKGROUND

It is believed that improved safety culture/climate is a fundamental element to accident prevention. Therefore, development a scale to assess safety climate is a step towards accident control. The purpose of this study was to construct a Persian safety climate questionnaire.

METHODS

The study took place in Tehran and Esfahan oil refineries in Iran in 2010. An initial questionnaire was formed from two previous studies. This tool was translated to Persian based on back translation. The 61-item questionnaire was tested on operational staffs (N=324). Principle component analysis and Varimax with Kaiser Normalization was used to extract factors, in statistical software package SPSS 11.0.

RESULTS

The factors were obtained as Management Commitment to Safety and personnel collaboration 23 variables, 17.33 % of the variance, Safety communication five items, 6.97% of the variance, Supportive environment five items, 6.245% of the variance, Work Environment six items, 5.590% of the variance, Formal Training four items, 4.581% of the variance, Priority of Safety five items, 4.177% of the variance, Personal Priorities and Need for Safety three items, 3.333% of the variance.

CONCLUSIONS

Achievement of a valid and reliable safety climate tool may bring enormous benefits to the refineries. However, a reliable and valid tool to measure safety climate could be useful in other refineries. Moreover, the generic nature of the safety climate scale may grant its use for other workplaces.

Evaluation of the morphological changes of gastric mucosa induced by a low concentration of acetic acid using a rat model

Oral ingestion of concentrated acetic acid causes corrosive injury of the gastrointestinal tract. To assess the effects of a low concentration of acetic acid on gastric mucosa, we examined the gastric mucosal changes in rats at 1 and 3 days after the injection of 5% or 25% acetic acid into the gastric lumen. The area of the gastric ulcerative lesions in the 25% acetic acid group was significantly larger than that in the 5% acetic acid group. The lesion area was reduced significantly at 3 days after injection in the 5% acetic acid group, whereas no significant difference in lesion area was observed at 1 and 3 days in the 25% acetic acid group. Histologically, corrosive necrosis was limited to the mucosal layer in the 5% acetic acid group, whereas necrosis extended throughout the gastric wall in the 25% acetic acid group. At 3 days post-injection, the 25% acetic acid group showed widespread persistent inflammation, whereas the 5% acetic acid group showed widespread appearance of fibroblasts indicative of a healing process. These results indicate that a low concentration of acetic acid damages the gastric mucosa and that the degree of mucosal damage depends on the concentration of acetic acid.

Revisiting exposure: fatal and non-fatal traffic injury risk across different populations of travelers in Wisconsin, 2001-2009

Comparing the injury risk of different travel modes requires using a travel-based measure of exposure. In this study we quantify injury risk by travel mode, age, race/ethnicity, sex, and injury severity using three different travel-based exposure measures (person-trips, person-minutes of travel, and person-miles of travel) to learn how these metrics affect the characterization of risk across populations. We used a linked database of hospital and police records to identify non-fatal injuries (2001-2009), the Fatality Analysis Reporting System for fatalities (2001-2009), and the 2001 Wisconsin Add-On to the National Household Travel Survey for exposure measures. In Wisconsin, bicyclists and pedestrians have a moderately higher injury risk compared to motor vehicle occupants (adjusting for demographic factors), but the risk is much higher when exposure is measured in distance. Although the analysis did not control for socio-economic status (a likely confounder) it showed that American Indian and Black travelers in Wisconsin face higher transportation injury risk than White travelers (adjusting for sex and travel mode), across all three measures of exposure. Working with multiple metrics to form comprehensive injury risk profiles such as this one can inform decision making about how to prioritize investments in transportation injury prevention.

Tracking hazardous air pollutants from a refinery fire by applying on-line and off-line air monitoring and back trajectory modeling

The air monitors used by most regulatory authorities are designed to track the daily emissions of conventional pollutants and are not well suited for measuring hazardous air pollutants that are released from accidents such as refinery fires. By applying a wide variety of air-monitoring systems, including on-line Fourier transform infrared spectroscopy, gas chromatography with a flame ionization detector, and off-line gas chromatography-mass spectrometry for measuring hazardous air pollutants during and after a fire at a petrochemical complex in central Taiwan on May 12, 2011, we were able to detect significantly higher levels of combustion-related gaseous and particulate pollutants, refinery-related hydrocarbons, and chlorinated hydrocarbons, such as 1,2-dichloroethane, vinyl chloride monomer, and dichloromethane, inside the complex and 10 km downwind from the fire than those measured during the normal operation periods. Both back trajectories and dispersion models further confirmed that high levels of hazardous air pollutants in the neighboring communities were carried by air mass flown from the 22 plants that were shut down by the fire. This study demonstrates that hazardous air pollutants from industrial accidents can successfully be identified and traced back to their emission sources by applying a timely and comprehensive air-monitoring campaign and back trajectory air flow models.

Sheep shearing and sudden death

A 29-year-old sheep shearer collapsed after walking across a shearing shed floor, holding his hand over an incised wound to his neck. Attempted resuscitation was unsuccessful. At the death scene fine arterial blood spatter was noted and at autopsy a single incised wound to the neck was observed, the patterned edges of which corresponded to the teeth of the shears. Dissection revealed injury to the underlying jugular vein and the mid portion of the common carotid artery. Death was attributed to blood loss from an incised wound of the left side of the neck. This case demonstrates the rare event of an accidental death related to the actions of a sheep. Although a relatively small animal, review of the circumstances and interviews with those present revealed that sudden and unexpected movement of the sheep during shearing had caused the shearer to lose control of his electrical shears resulting in a lethal incised wound to the neck. The blood spatter pattern at the scene was supportive of both witness descriptions and the findings at autopsy.

Ejection of a rear facing, golf cart passenger

The following report details the findings of a series of experiments and simulations performed on a commercially available, shuttle style golf cart during several maneuvers involving rapid accelerations of the vehicle. It is determined that the current set of passive restraints on these types of golf carts are not adequate in preventing ejection of a rear facing passenger during rapid accelerations in the forward and lateral directions. Experimental data and simulations show that a hip restraint must be a minimum of 13 in. above the seat in order to secure a rear facing passenger during sharp turns, compared to the current restraint height of 5 in. Furthermore, it is determined that a restraint directly in front of the rear facing passenger is necessary to prevent ejection. In addressing these issues, golf cart manufacturers could greatly reduce the likelihood of injury due to ejection of a rear facing, golf cart passenger.

A new process-centered description tool to initiate meta-reporting methodology in healthcare - 7CARECAT™. Feasibility study in a post-anesthesia care unit

BACKGROUND

In the healthcare domain, different analytic tools focused on accidents appeared to be poorly adapted to sub-accidental issues. Improving local management and intra-institutional communication with simpler methods, allowing rapid and uncomplicated meta-reporting, could be an attractive alternative.

METHODS

A process-centered structure derived from the industrial domain - DEPOSE(E) - was selected and modified for its use in the healthcare domain. The seven exclusive meta-categories defined - Patient, Equipment, Process, Actor, Supplies, work Room and Organization- constitute 7CARECAT™. A collection of 536 "improvement" reports from a tertiary hospital Post anesthesia care unit (PACU) was used and four meta-categorization rules edited prior to the analysis. Both the relevance of the metacategories and of the rules were tested to build a meta-reporting methodology. The distribution of these categories was analyzed with a χ 2 test.

RESULTS

Five hundred and ninety independent facts were collected out of the 536 reports. The frequencies of the categories are: Organization 44%, Actor 37%, Patient 11%, Process 3%, work Room 3%, Equipment 1% and Supplies 1%, with a p-value <0.005 (χ 2). During the analysis, three more rules were edited. The reproducibility, tested randomly on 200 reports, showed a <2% error rate.

CONCLUSION

This meta-reporting methodology, developed with the 7CARECAT™ structure and using a reduced number of operational rules, has successfully produced a stable and consistent classification of sub-accidental events voluntarily reported. This model represents a relevant tool to exchange meta-informations important for local and transversal communication in healthcare institutions. It could be used as a promising tool to improve quality and risk management.

Benzodiazepine use during buprenorphine treatment for opioid dependence: clinical and safety outcomes

BACKGROUND

Prescribing benzodiazepines during buprenorphine treatment is a topic of active discussion. Clinical benefit is unclear. Overdose, accidental injury, and benzodiazepine misuse remain concerns. We examine the relationship between benzodiazepine misuse history, benzodiazepine prescription, and both clinical and safety outcomes during buprenorphine treatment.

METHODS

We retrospectively examined outpatient buprenorphine treatment records, classifying patients by past-year benzodiazepine misuse history and approved benzodiazepine prescription at intake. Primary clinical outcomes included 12-month treatment retention and urine toxicology for illicit opioids. Primary safety outcomes included total emergency department (ED) visits and odds of an ED visit related to overdose or accidental injury during treatment.

RESULTS

The 12-month treatment retention rate for the sample (N=328) was 40%. Neither benzodiazepine misuse history nor benzodiazepine prescription was associated with treatment retention or illicit opioid use. Poisson regressions of ED visits during buprenorphine treatment revealed more ED visits among those with a benzodiazepine prescription versus those without (p<0.001); benzodiazepine misuse history had no effect. The odds of an accidental injury-related ED visit during treatment were greater among those with a benzodiazepine prescription (OR: 3.7, p<0.01), with an enhanced effect among females (OR: 4.7, p<0.01). Overdose was not associated with benzodiazepine misuse history or prescription.

CONCLUSIONS

We found no effect of benzodiazepine prescriptions on opioid treatment outcomes; however, benzodiazepine prescription was associated with more frequent ED visits and accidental injuries, especially among females. When prescribing benzodiazepines during buprenorphine treatment, patients need more education about accidental injury risk. Alternative treatments for anxiety should be considered when possible, especially among females.

A randomized controlled trial of brief motivational interviewing in impaired driving recidivists: a 5-year follow-up of traffic offenses and crashes

Background

In a previously published randomized controlled trial (Brown et al. Alcohol Clin Exp Res 2010; 34, 292–301), our research team showed that a 30-minute brief motivational interviewing (BMI) session was more effective in reducing percentages of risky drinking days in drunk driving recidivists than a control information–advice intervention at 12-month follow-up. In this sequel to the initial study, 2 main hypotheses were tested: (i) exposure to BMI increases the time to further arrests and crashes compared with exposure to the control intervention (CTL) and (ii) characteristics, such as age, moderate the benefit of BMI.

Methods

A sample of 180 community-recruited recidivists who had drinking problems participated in the study. Participants gave access to their provincial driving records at baseline and were followed up for a mean of 1,684.5 days (SD = 155.7) after randomization to a 30-minute BMI or CTL session. Measured outcomes were driving arrests followed by convictions including driving while impaired (DWI), speeding, or other moving violations as well as crashes. Age, readiness to change alcohol consumption, alcohol misuse severity, and number of previous DWI convictions were included as potential moderators of the effect of the interventions.

Results

For arrests, Cox proportional hazards modeling revealed no significant differences between the BMI and the CTL group. When analyses were adjusted to age tertile categories, a significant effect of BMI in the youngest age tertile (<43 years old) emerged. For crashes, no between-group differences were detected.

Conclusions

BMI was better at delaying DWI and other dangerous traffic violations in at-risk younger drivers compared with a CTL similar to that provided in many remedial programs. BMI may be useful as an opportunistic intervention for DWI recidivism prevention in settings such as DWI courts. Treatment effectiveness studies are needed to ascertain how the present findings generalize to the real-world conditions of mandated relicensing programs.

Categorizing accident sequences in the external radiotherapy for risk analysis

Purpose

This study identifies accident sequences from the past accidents in order to help the risk analysis application to the external radiotherapy.

Materials and Methods

This study reviews 59 accidental cases in two retrospective safety analyses that have collected the incidents in the external radiotherapy extensively. Two accident analysis reports that accumulated past incidents are investigated to identify accident sequences including initiating events, failure of safety measures, and consequences. This study classifies the accidents by the treatments stages and sources of errors for initiating events, types of failures in the safety measures, and types of undesirable consequences and the number of affected patients. Then, the accident sequences are grouped into several categories on the basis of similarity of progression. As a result, these cases can be categorized into 14 groups of accident sequence.

Results

The result indicates that risk analysis needs to pay attention to not only the planning stage, but also the calibration stage that is committed prior to the main treatment process. It also shows that human error is the largest contributor to initiating events as well as to the failure of safety measures. This study also illustrates an event tree analysis for an accident sequence initiated in the calibration.

Conclusion

This study is expected to provide sights into the accident sequences for the prospective risk analysis through the review of experiences.

[Risk analysis in radiation therapy: state of the art]

Five radiotherapy accidents, from which two serial, occurred in France from 2003 to 2007, led the authorities to establish a roadmap for securing radiotherapy. By analogy with industrial processes, a technical decision form the French Nuclear Safety Authority in 2008 requires radiotherapy professionals to conduct analyzes of risks to patients. The process of risk analysis had been tested in three pilot centers, before the occurrence of accidents, with the creation of cells feedback. The regulation now requires all radiotherapy services to have similar structures to collect precursor events, incidents and accidents, to perform analyzes following rigorous methods and to initiate corrective actions. At the same time, it is also required to conduct analyzes a priori, less intuitive, and usually require the help of a quality engineer, with the aim of reducing risk. The progressive implementation of these devices is part of an overall policy to improve the quality of radiotherapy. Since 2007, no radiotherapy accident was reported.

Road traffic accidents in Kazakhstan

BACKGROUND

The article provides the analysis of death rates in road traffic accidents in Kazakhstan from 2004 to 2010 and explores the use of sanitary aviation.

METHODS

Data of fatalities caused by road traffic accidents were collected and analysed. Descriptive and analytical methods of epidemiology and biomedical statistics were applied.

RESULTS

Totaly 27,003 people died as a result of road traffic accidents in this period. The death rate for the total population due to road traffic accidents was 25.0±2.1(0)/0000. The death rate for men was (38.3±3.2(0)/0000), which was higher (P<0.05) than that for women (12.6±1.1(0)/0000). High death rates in the entire male population were identified among men of 30-39 years old, whereas the highest rates for women were attributed to the groups of 50-59 years old and 70-79 years old. In time dynamics, death rates tended to decrease: the total population (Tdec=-2.4%), men (Tdec=-2.3%) and women (Tdec=-1.4%). When researching territorial relevance, the rates were established as low (to 18.3(0)/0000), average (between 18.3 and 24.0(0)/0000) and high (from 24.0(0)/0000 and above). Thus, the regions with high rates included Akmola region (24.3(0)/0000), Mangistau region (25.9(0)/0000), Zhambyl region (27.3(0)/0000), Almaty region (29.3(0)/0000) and South Kazakhstan region (32.4(0)/0000).

CONCLUSION

The identified epidemiological characteristics of the population deaths rates from road traffic accidents should be used in integrated and targeted interventions to enhance prevention of injuries in accidents.

Mysterious foreign body in transverse sinus

This case report describes a patient who had a foreign body in transverse sinus. A 35-year-old Korean-Chinese man visited the emergency room with lacerated wound in left eyelid and a foreign body which was stumbled upon in the skull. On examination, there was right side hemianopsia in his left eye. He did not complain any headache or show any abnormal neurological signs, but there was a foreign body at left transverse sinus in computed tomography which was taken at another hospital. There was no intracranial abnormality except the foreign body in computed tomography. Because of the financial problem, additional evaluations were not possible. We herein report a strange case in which the pathway of a foreign body to locate in transverse sinus was ambiguous, and suggest that the foreign body located in transverse sinus might have been the penetrated along the anterior fontanelle and passed through the superior sagittal sinus.

Predictive Power of Incidents Reporting Rate and Its Dimensions by Job Stress among Workers' Isfahan Steel Company

BACKGROUND

There is long-term interest in the effects of stress on health, due to the strain that it places on individuals which can lead to an increased risk of disease. The present study examined degree of perceived job stress related to incidents reporting rate and its dimensions among workers' Isfahan Steel Company.

METHODS

A self-administered anonymous was distributed to 189 workers. The survey included demographic factors, incidents reporting rate and its components (physical symptoms, psychological symptoms and accidents) and the Job Stress Questionnaire. The data were analyzed by multivariate (MANOVA) and correlation techniques.

RESULTS

1) there was internal significant correlation between perceived job stress with incident reporting rate as well as with its two components namely physical symptoms and psychological symptoms; 2) there was not a significant relationship between perceived job stress and accident; 2) In multivariate analysis, perceived job stress respectively about 12%, 18% and 19% of the variance of variables of incidents reporting rate, physical and psychological symptoms significantly predicted (P< 0.05).

CONCLUSION

Perceived job stress influences to physical and psychological symptoms. Therefore, decreasing job stress can be important to prevent the development of stress-related diseases and to promote workers health.

Association of Subway Driver's Depressive Symptoms and Experience of Work-Related Problems

OBJECTIVES

Subway drivers experience various types of work-related problems during their driving, and those experiences can act as risk factors for depressive symptoms. This study was conducted to investigate the association between work-related problems and subway driver's depressive symptoms.

METHODS

We recruited all of the 961 current subway drivers of a subway company located in Seoul, South Korea and conducted a survey of their socio-demographic and vocational characteristics, hospital visits as an outpatient or inpatient, and work-related problem experiences during the last year. Work-related problems included an accident resulting in death or injury, a conflict with a customer, a sudden stop from an emergency bell, or a near accident. Depressive symptoms were measured with the Center for Epidemiologic Studies-Depression (CES-D) instrument. The survey was performed using a self-report questionnaire from April 16 to July 13, 2007. The data of 827 drivers (86.2%) were analyzed.

RESULTS

Experience of a conflict with a passenger (p=0.011), a sudden stop from an emergency bell (p=0.001), or a near accident (p=0.001) increased the prevalence of depressive symptoms among subway drivers. A multiple logistic regression analysis revealed that a sudden stop from an emergency bell increased the risk of depressive symptoms significantly (OR=2.59, p=0.026). Near accidents were marginally associated with a higher risk for depressive symptoms (OR=1.62, p=0.062).

CONCLUSION

The experience of a sudden stop from an emergency bell increased subway driver's depressive symptoms, and near accidents may increase the risk of depressive symptoms. Therefore, interventions for the drivers who had experienced these work-related problems are needed.

School-related injuries: a retrospective 5-year evaluation

PURPOSE

Children and adolescents spend up to 50% of their time at school. The purpose of this study was to assess injury patterns of school accidents (along with their treatment) in the trauma center of a German university hospital, and to compare these data to those in the literature.

METHODS

All school accidents treated in a level 1 pediatric trauma center over a five-year period were statistically analyzed in a retrospective manner by chart review.

RESULTS

There were 1,399 school accidents that were treated in our department. Average age of the injured person was 11.8 years, with a boy:girl ratio of 3:2. Almost 40% of the injuries occurred during school sports. The most frequently injured region was the upper extremity, including the hand (36.8%). Distortion and contusion was the most frequent diagnosis among all injuries. Sixteen percent of the cases had to be treated surgically and/or under general anesthesia, and 16% of the patients had to be admitted to the hospital.

CONCLUSION

It can be concluded that special attention must be paid during school sporting activities and breaks because they account for most of the accidents. Traffic education may reduce severe injuries. Specific knowledge of the growing long bones of the upper extremity and the hand is important for the diagnosis and treatment of school accidents.

Driving errors, driving violations and accident involvement

A survey of over 1600 drivers is reported, the results of which are consistent with those reported in an earlier study (Reason et al. 1990), which identified a three-fold typology of aberrant driving behaviours. The first type, lapses, are absent-minded behaviours with consequences mainly for the perpetrator, posing no threat to other road users. The second type, errors, are typically misjudgements and failures of observation that may be hazardous to others. The third type, violations, involve deliberate contraventions of safe driving practice. In the present study the survey instrument used, the Driver Behaviour Questionnaire, was also shown to be reliable over time. Each type of behaviour was found to have different demographic correlates. Most importantly, accident liability was predicted by self-reported tendency to commit violations, but not by tendency to make errors or to have lapses. The implications for road safety are discussed.